Provider Demographics
NPI:1912063439
Name:COOK COUNTY
Entity type:Organization
Organization Name:COOK COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-864-4649
Mailing Address - Street 1:15900 SOUTH CICERO AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-4000
Mailing Address - Country:US
Mailing Address - Phone:708-633-3400
Mailing Address - Fax:708-633-3407
Practice Address - Street 1:605 S WOLCOTT AVE, SUITE 605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-864-4649
Practice Address - Fax:312-864-9763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
IL0001743283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283X00000XHospitalsRehabilitation Hospital
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL0048OtherIRF BCBS
IL14T301Medicare ID - Type UnspecifiedIRF